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Nutrition Screening in the Pediatric Intensive Care Unit: Evaluation of an Electronic Medical Record-Based Tool
Julia Hilbrands1, Mary Beth Feuling1, Aniko Szabo2
1Clinical Nutrition, Children's Wisconsin, Milwaukee, WI 53226, USA.
Insights
The Children's Wisconsin Nutrition Screening Tool (CWNST) shows high sensitivity for detecting malnutrition in critically ill children in the pediatric intensive care unit (PICU). While effective, improvements are needed to increase its specificity for better clinical application.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Healthcare informatics
Background:
- Critically ill children in pediatric intensive care units (PICUs) face a high risk of malnutrition.
- Existing pediatric nutrition screening tools lack validation in PICU settings.
- The Children's Wisconsin Nutrition Screening Tool (CWNST) integrates the Pediatric Nutrition Screening Tool (PNST) with electronic medical record data.
Purpose of the Study:
- To evaluate the performance of the CWNST in identifying potential malnutrition among critically ill children.
- To compare the effectiveness of CWNST against the PNST alone in a PICU population.
Main Methods:
- Retrospective analysis of 250 patients admitted to PICUs at Children's Wisconsin in 2019 with at least one dietitian nutrition assessment.
- Inclusion of screening elements, diagnoses, and nutrition status data.
- Comparison of CWNST performance metrics (sensitivity, specificity, PPV, NPV) against PNST alone.
Main Results:
- The CWNST demonstrated high sensitivity (0.985) but low specificity (0.06) for detecting malnutrition.
- Predictive elements for malnutrition included parenteral nutrition, positive PNST, and abnormal BMI-for-age/weight-for-length z-scores.
- A significant majority of patients (97.2%) received a positive nutrition screen using CWNST.
Conclusions:
- The CWNST is a sensitive tool for predicting nutrition risk in PICU patients and can be integrated via electronic medical records.
- Further refinement of the CWNST is necessary to enhance its specificity and reduce false positives.
Abstract:
Hospitalized, critically ill children are at increased risk of developing malnutrition. While several pediatric nutrition screening tools exist, none have been validated in the pediatric intensive care units (PICU). The Children's Wisconsin Nutrition Screening Tool (CWNST) is a unique nutrition screening tool that includes the Pediatric Nutrition Screening Tool (PNST) and predictive elements from the electronic medical record and was found to be more sensitive than the PNST in acute care units. The aim of this study was to assess the performance of the tool in detecting possible malnutrition in critically ill children. The data analysis, including the results of the current nutrition screening, diagnosis, and nutrition status was performed on all patients admitted to PICUs at Children's Wisconsin in 2019. All 250 patients with ≥1 nutrition assessment by a dietitian were included. The screening elements that were predictive of malnutrition included parenteral nutrition, positive PNST, and BMI-for-age/weight-for-length z-score. The current screen had a sensitivity of 0.985, specificity of 0.06, positive predictive value (PPV) of 0.249, and negative predictive value of 0.929 compared to the PNST alone which had a sensitivity of 0.1, specificity of 0.981, PPV of 0.658, and NPV of 0.749. However, of the 250 included patients, 97.2% (243) had a positive nutrition screen. The CWNST can be easily applied through EMRs and predicts the nutrition risk in PICU patients but needs further improvement to improve specificity.
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